Provider Demographics
NPI:1205126786
Name:MUNDON, RACHAEL ELIZABETH (OTR/L)
Entity type:Individual
Prefix:MS
First Name:RACHAEL
Middle Name:ELIZABETH
Last Name:MUNDON
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1826 BRODERICK ST APT 16
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94115-2444
Mailing Address - Country:US
Mailing Address - Phone:832-265-3290
Mailing Address - Fax:
Practice Address - Street 1:1826 BRODERICK ST APT 16
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-2444
Practice Address - Country:US
Practice Address - Phone:832-265-3290
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-18
Last Update Date:2011-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT 11475225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist